Seminars in Dialysis最新文献

{"title":"The Revival of Sorbents in Chronic Dialysis Treatment.","authors":"Jeroen Peter Kooman","doi":"10.1111/sdi.13203","DOIUrl":"https://doi.org/10.1111/sdi.13203","url":null,"abstract":"<p><p>Interest in the use of sorbents in chronic dialysis treatment has undergone a revival in the last decades, for which two major factors are responsible. The first is the potential of sorbents as adjunct therapy for the removal of substances that are difficult to remove by conventional dialysis therapies. The second is their use in regeneration of dialysate, which is of pivotal importance in the design of portable or even wearable treatments, next to the potential for reducing water use during conventional dialysis treatment. Sorbent-enhanced dialysis with synthetic polymers was associated with a reduction in inflammatory parameters as compared to hemodialysis and even associated with improved survival in smaller studies, although this needs to be confirmed in large randomized trials. Incorporation of sorbents within a dialysis membrane (mixed matrix membrane) appears a promising way forward to reduce the complexity and costs of a dual therapy but needs to be tested in vivo. For regeneration of dialysate, at present, a combination of urease, zirconium-based sorbents, and activated charcoal is used. Next to sodium release by the sorbent in exchange for ammonium and the CO₂ release by the hydrolysis of urea has been a bottleneck in the design of wearable devices, although short-term trials have been performed. Still, for widespread and flexible application of sorbent-assisted portable or wearable devices, a direct urea sorbent would be a major asset. In the near future, it will likely become apparent whether sorbent-assisted dialysis techniques are feasible for routine implementation in clinical practice.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140176323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodialysis vascular access coordinator: Three-level model for access management.","authors":"Clemente Neves Sousa, Paulo Teles, Rui Sousa, Filipa Cabrita, Olga Maria Pimenta Lopes Ribeiro, Elisabete Delgado, Sara Coutinho, Sandra Cristina Mendo Moura, Millena Freire Delgado, João Filipe Costa, Tiago Gomes Sá, Sílvia Mónica Pereira Teixeira, Ana Elza Oliveira Mendonça, Nurten Ozen","doi":"10.1111/sdi.13153","DOIUrl":"10.1111/sdi.13153","url":null,"abstract":"<p><p>Management of vascular access is a challenge for the dialysis team, particularly to keep the arteriovenous access working. The vascular access coordinator can positively contribute to increase the number of arteriovenous fistulas and reduce central venous catheters. In this article, we introduce a new approach to vascular access management centered on (the results of setting up) the role of vascular access coordinator. We described the three-level model (3Level_M) for vascular access management organized in three levels: vascular access nurse manager, vascular access coordinator, and vascular access consultant. We defined the instrumental skills and training required to be developed by each element and clarify the articulation between the model and all members of the dialysis team related to vascular access.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"85-90"},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9251423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pantoea agglomerans: A rare infectious outbreak affecting maintenance hemodialysis patients in a tertiary care hospital.","authors":"Danyal Hassan, Nida Saleem, Muhammad Haneef, Merina Khan, Maliha Aziz, Muhammad Usman","doi":"10.1111/sdi.13182","DOIUrl":"10.1111/sdi.13182","url":null,"abstract":"<p><strong>Background: </strong>Pantoea agglomerans is an environmental pathogen known to cause infection in immunocompromised individuals, particularly after thorn injuries. However, previous data showed few cases of human disease caused by contaminated medical products such as parenteral nutrition, anesthetic agents, blood, and peritoneal dialysis solutions. Infection in hemodialysis patients is rare. In this study, we presented a detailed account of several hemodialysis patients infected with this contagious pathogen and compared them with noninfected dialysis patients.</p><p><strong>Methods: </strong>We retrospectively reviewed the hospital records of 105 hemodialysis patients. Seventeen of 105 patients were diagnosed with P. agglomerans infection. We carefully analyzed their entire in-hospital course.</p><p><strong>Results: </strong>Among infected patients, 52.9% were male with a median age of 49 (IQR: 32-66) years. Compared to the noninfected patients, age below 50 years, prior kidney transplantation, prior immunosuppression and antibiotics use, and dialysis via a tunneled vascular catheter were the significant epidemiological features. Despite negative microbiological investigations, we suspect the possible infectious spread via infected central venous catheter was the likely infectious source. Most importantly, all patients responded well to intravenous antibiotics. Only two patients required the removal of the tunneled catheter. Their mortality rate was 0%.</p><p><strong>Conclusion: </strong>P. agglomerans infection, although considered rare, is becoming increasingly prevalent among dialysis patients. Its occurrence must be appraised as an infectious outbreak rather than mere contamination. Prompt treatment, source identification, and early implementation of preventive strategies should always be the goal to curtail this infection at an early stage.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"172-177"},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41129338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous tendon or ligament ruptures in patients undergoing dialysis: First pediatric case report and literature review.","authors":"Behruz Huseynli, Bahar Büyükkaragöz, Emre Leventoğlu, Kibriya Fidan, Sevcan A Bakkaloğlu, Akif Muhtar Öztürk, Oğuz Söylemezoğlu","doi":"10.1111/sdi.13192","DOIUrl":"10.1111/sdi.13192","url":null,"abstract":"<p><p>Spontaneous tendon or ligament ruptures are quite rare and mostly associated with chronic systemic diseases such as diabetes mellitus, systemic lupus erythematosus, rheumatoid arthritis, and chronic kidney disease (CKD). In this study, we present the first documented case of a spontaneous rupture of the medial patellofemoral ligament (MPFL) in a pediatric patient. The patient was undergoing long-term peritoneal dialysis (PD) and had a history of severe secondary hyperparathyroidism. Additionally, we discussed spontaneous tendon and ligament ruptures associated with CKD or dialysis through a comprehensive literature review. This case report highlights the importance of recognizing that spontaneous tendon or ligament injuries are not exclusive to adults; children with CKD can also be affected. Several factors including poor parathyroid hormone (PTH) and metabolic acidosis control, prolonged CKD duration and presence of malnutrition play role in the pathogenesis. Early diagnosis is crucial as it allows for timely surgical intervention and leads to a favorable functional recovery.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"122-130"},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139479196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a native vein arteriovenous fistula tracking system.","authors":"Lingyan Meng, Jun Jie Ng, Andrew Mark Tze Liang Choong, Rajesh Babu Dharmaraj, Raj Menon, Julian Chi Leung Wong, Susan Ching, Yen Feng Wong, Jaqueline Kong, Pei Ho","doi":"10.1111/sdi.13179","DOIUrl":"10.1111/sdi.13179","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the effectiveness of a tracking program on the functional maturation rate of arteriovenous fistula (AVF).</p><p><strong>Methods: </strong>Two major clinical outcomes (commencement of cannulation and functional maturation) of created AVFs were compared between two cohorts. (i) Cohort 1: historical cohort; (ii) Cohort 2: AVFs created after implementation of the tracking project. Multivariable Cox regression models were used to assess the association between cohort allocation and the two major clinical outcomes.</p><p><strong>Results: </strong>Data of 114 and 141 patients were analyzed respectively from Cohorts 1 (historical data) and 2 (with AVF tracking). After adjustment of covariates in the multivariable analysis, the AVFs created in Cohort 2 were more likely to be cannulated earlier (adjusted HR: 2.82; 95% CI: 1.97-4.05; p < 0.001), compared to those in Cohort 1. Similarly, the AVFs of Cohort 2 patients had significantly higher probability of functional maturation (adjusted HR: 1.81; 95% CI: 1.31-2.48; p < 0.001) than fistulas in Cohort 1. Cannulation was commenced for half of the AVFs by 4.1 months post-creation in the historical cohort (Cohort 1), whereas in the post-tracking cohort, 50% of the AVFs were cannulated by 2.3 months after creation (p < 0.001). It took 5.5 and 4.3 months for 50% of the AVFs created in Cohort 1 and Cohort 2 patients to achieve catheter-free functional maturation, respectively (p = 0.06).</p><p><strong>Conclusion: </strong>An AVF tracking program with maturation target for the access surgeons, together with a standardized tracking, feedback, and clinical strategy adjustment system is able to improve the AVF functional maturation rate.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"161-171"},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41135553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The comparison of paricalcitol and calcitriol effects on pulse wave velocity, osteocalcin, and fetuin-A in chronic hemodialysis patients.","authors":"Suleyman Karakose, Zeynep Bal, Siren Sezer","doi":"10.1111/sdi.13167","DOIUrl":"10.1111/sdi.13167","url":null,"abstract":"<p><strong>Introduction: </strong>Vascular calcification is an intervenable factor in the pathophysiology of cardiovascular disease. Treatment-related factors might worsen the arterial stiffness in chronic hemodialysis patients. The aim of the study is to compare the effects of 1-year treatment with paricalcitol or calcitriol on pulse wave velocity (PWV), which is an indicator of arterial stiffness and osteocalcin and fetuin-A levels.</p><p><strong>Methods: </strong>Seventy-six hemodialysis patients who had similar PWV1 at the beginning were evaluated after a 1-year treatment of paricalcitol or calcitriol. PWV2, serum osteocalcin, and fetuin-A levels were measured at the end of the study.</p><p><strong>Results: </strong>At the end of the study, PWV2 of paricalcitol group was statistically lower than the calcitriol group. Osteocalcin levels were statistically lower and fetuin-A levels were statistically higher in the paricalcitol group than the calcitriol group at the end of the study. The number of patients with PWV2 > 7 m/s and using paricalcitol was 16 (39%) but 25 (41%) patients were using calcitriol; the differences were statistically significant.</p><p><strong>Conclusions: </strong>The long-term benefits of paricalcitol were superior to the benefits of calcitriol. Paricalcitol has protective effects from vascular calcification in chronic hemodialysis patients.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"131-137"},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9724969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring clinical evaluation indicators for predicting coagulation in the extracorporeal circulation circuit in hemodialysis patients receiving individualized regional citrate anticoagulation-A single-center, retrospective clinical study.","authors":"Menglin Zou, Feifei Wu, Yanna Fan, Yanyan Gong, Zhen Hu, Tin Jiang, Chenfu Gan, Laimin Luo","doi":"10.1111/sdi.13183","DOIUrl":"10.1111/sdi.13183","url":null,"abstract":"<p><strong>Background: </strong>Citrate anticoagulation is an important anticoagulation method in hemodialysis (HD) but cannot completely prevent the occurrence of coagulation in the extracorporeal circulation (ECC) circuit, and the clinical coagulation status can significantly affect the effect of citrate anticoagulation. In this study, the relationships between clinical coagulation status indicators and coagulation in the ECC circuit in HD patients receiving individualized citrate anticoagulant were studied to explore indicators that may predict coagulation in the ECC circuit.</p><p><strong>Methods: </strong>This study was a single-center, retrospective clinical study, and clinical data and laboratory tests related to the coagulation status of HD patients receiving individualized regional citrate anticoagulation (RCA) were collected. The relationships between indicators commonly used in clinical practice to evaluate clinical coagulation status and coagulation in the ECC circuit were statistically analyzed to find indicators that can predict the occurrence of coagulation in the ECC circuit.</p><p><strong>Results: </strong>The individualized RCA had a good anticoagulation effect, and the actual citrate infusion rate in nearly 80% of the patients was within ±10% of the theoretical infusion rate. The combined diseases or conditions that affect the coagulation status in vivo may increase the incidence of coagulation in the ECC circuit. The clinical D-dimer level is an independent risk factor that affects and can predict coagulation in the ECC circuit, with a cutoff value of 2.03 mg/L, sensitivity of 59%, and specificity of 78%.</p><p><strong>Conclusion: </strong>Individualized RCA can meet the needs of most HD treatments. Abnormal coagulation status in HD patients may increase the incidence of coagulation in the ECC circuit during individualized RCA for HD, and the D-dimer level can predict the occurrence of coagulation in the ECC circuit during this treatment.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"178-185"},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41136552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of young and old patients on peritoneal dialysis: A retrospective observational study.","authors":"Erdem Çankaya, Murat Altunok","doi":"10.1111/sdi.13180","DOIUrl":"10.1111/sdi.13180","url":null,"abstract":"<p><strong>Background: </strong>With a global increase in life expectancy around the world, the burden of chronic kidney disease in the elderly is increasing. The number of elderly patients undergoing peritoneal dialysis (PD) is also increasing. There is still a perception that PD may be associated with an increased risk of complications in these elderly patients.</p><p><strong>Methods: </strong>A total of 311 patients, of which 103 PD patients aged 65 and over and 208 PD patients under 65 years of age, were followed in a single center and evaluated, retrospectively. Demographic data of these patients, albumin values at first PD and during PD time, residual urine amount, number of peritonitis, time to the first peritonitis attack, PD endpoints, and mortality were compared.</p><p><strong>Results: </strong>Peritonitis and technique failure rates were lower in patients aged 65 and over who applied PD (0.61-0.75, 6.8%-23.1%, respectively). There was no difference in peritonitis-free survival (p = 0.931). Need for help HR 2.569 [95%CI 1.564-4.219] (p < 0.05), time to first peritonitis attack HR 0.983 [95%CI 0.974-0.992] (p < 0.05), mean albumin value HR 0.191 [95%CI 0.088-0.413] (p < 0.05), urine output level HR 1.154 [95%CI 1.010-1.318] (p < 0.05) were factors affecting mortality.</p><p><strong>Conclusion: </strong>Peritonitis and technical survival evaluations of elderly PD patients, other than mortality, were lower than younger PD patients. However, the need for help is one of the biggest obstacles to this method for the elderly. We believe that incentives in this regard will increase the number of elderly PD patients.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"153-160"},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41179858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of functional impairment and mortality in patients on maintenance hemodialysis.","authors":"Neha Jain, Ravi Bansal, Sanjiv Saxena, Sourabh Sharma, Sree Bhushan Raju","doi":"10.1111/sdi.13173","DOIUrl":"10.1111/sdi.13173","url":null,"abstract":"<p><strong>Introduction: </strong>Numerous factors impact the mortality and functional abilities of patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis (MHD). We aimed to determine the mortality rate at 1 year of MHD, identify predictors of mortality, and assess functional impairments concerning activities of daily living (ADLs) and instrumental ADL (IADL).</p><p><strong>Methods: </strong>Our study was prospective, observational cohort study that enrolled patients receiving MHD. We collected demographic, clinical, and laboratory data. We also assessed ADLs and IADLs for daily performance.</p><p><strong>Results: </strong>Our study included 167 patients with a mean age of 51.6 ± 13.1 years, and 56.9% were male. Of these, 80 (47.9%) were diabetic, and 145 (86.8%) were hypertensive. The mortality rate after 1 year of MHD was 10.8%, and cardiovascular causes accounted for over 70% of total deaths. Sudden cardiac death was the most frequent cause (38.9%), followed by cardiogenic shock (22.2%). Older age and low parathormone levels (<300 pg/mL) were significantly associated with higher mortality rates. Mean ADL and IADL scores were 4.5 ± 1.3 and 6.3 ± 2.7, respectively. Eighteen (10.8%) and 56 (33.5%) patients had low ADL and IADL scores, respectively. Although statistically insignificant, a higher proportion of non-survivors exhibited low IADL and ADL scores. Older age, longer diabetes duration, and higher BMI levels were significantly associated with lower IADL scores.</p><p><strong>Conclusions: </strong>Older age and suppressed PTH levels are predictors of mortality in ESRD patients receiving MHD. These patients require regular follow-ups to rule out cardiovascular morbidity. Functional impairment is prevalent but remains underdiagnosed in MHD patients. It should be monitored regularly to improve quality of life in ESRD.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"138-144"},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10416028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk prediction models for cardiovascular events in hemodialysis patients: A systematic review.","authors":"Tiantian Gan, Hua Guan, Pengli Li, Xinping Huang, Yue Li, Rui Zhang, Tingxin Li","doi":"10.1111/sdi.13181","DOIUrl":"10.1111/sdi.13181","url":null,"abstract":"<p><strong>Objective: </strong>To perform a systematic review of risk prediction models for cardiovascular (CV) events in hemodialysis (HD) patients, and provide a reference for the application and optimization of related prediction models.</p><p><strong>Methods: </strong>PubMed, The Cochrane Library, Web of Science, and Embase databases were searched from inception to 1 February 2023. Two authors independently conducted the literature search, selection, and screening. The Prediction model Risk Of Bias Assessment Tool (PROBAST) was applied to evaluate the risk of bias and applicability of the included literature.</p><p><strong>Results: </strong>A total of nine studies containing 12 models were included, with performance measured by the area under the receiver operating characteristic curve (AUC) lying between 0.70 and 0.88. Age, diabetes mellitus (DM), C-reactive protein (CRP), and albumin (ALB) were the most commonly identified predictors of CV events in HD patients. While the included models demonstrated good applicability, there were still certain risks of bias, primarily related to inadequate handling of missing data and transformation of continuous variables, as well as a lack of model performance validation.</p><p><strong>Conclusion: </strong>The included models showed good overall predictive performance and can assist healthcare professionals in the early identification of high-risk individuals for CV events in HD patients. In the future, the modeling methods should be improved, or the existing models should undergo external validation to provide better guidance for clinical practice.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"101-109"},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41165019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}